The beginning of the end

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nexus73 said:
I think psychiatry became more popular for a period of time, probably related to increased reimbursement with e/m coding and therapy add ons, and perceived improved acceptance by society and reduced stigma. But stigma still permeates everything I do at the hospital, even among doctors and physician administrators, who should know better or have better perspective on what psychiatry does. But in all fairness, they had 4 weeks of psych rotation in 3rd med school, so they really don't know what psychiatry is all about. And improved reimbursement is great, but inflation is running wild with no sign of reimbursement catching up. Getting a psych job at 280K sounds fine to pay off 200K in loans 5-10 years ago. But maybe the dream of psych as a lower paying ROAD specialty are going out the window with people eyeing the 400K plus starting salaries of anesthesia as they're facing down 500K in student loans.
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If you are facing down 500k in student loans the answer is abundantly clear that PSLF is the way to go and the eventual income you make has little to no impact on paying off the loans. Yes, you need to commit to 6 (or 5 with a fellowship) years of a qualifying job but that's extremely doable in psychiatry. If you are left with making 300k in psych vs 400k in something else the actual change to your happiness from the delta on income is almost certainly going to be less than the change due to you being in a field you care less about. If you happen to be the 1:1000 people that can match anesthesia and would be equally happy in either field, that sure, do gas, but for everyone else student loan burden should not be the driving the factor given how robust PSLF has become.

Otherwise if the idea of making 300-350k (which is the range for most psychiatrists I personally know) is not good enough for you, I would argue you made a big mistake going into medicine generally and/or need a significant re-evaluation of the role of money in your life and what you hope to accomplish making significantly more than that.
 
nexus73 said:
I think psychiatry became more popular for a period of time, probably related to increased reimbursement with e/m coding and therapy add ons, and perceived improved acceptance by society and reduced stigma. But stigma still permeates everything I do at the hospital, even among doctors and physician administrators, who should know better or have better perspective on what psychiatry does. But in all fairness, they had 4 weeks of psych rotation in 3rd med school, so they really don't know what psychiatry is all about. And improved reimbursement is great, but inflation is running wild with no sign of reimbursement catching up. Getting a psych job at 280K sounds fine to pay off 200K in loans 5-10 years ago. But maybe the dream of psych as a lower paying ROAD specialty are going out the window with people eyeing the 400K plus starting salaries of anesthesia as they're facing down 500K in student loans.
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more like 500k in anes/rads now as standard
 
My spouse is a physician and they have absolutely 0 sense of our financial situation no matter how our income swings. Doesnt impact their life in the slightest. I say this to underscore Merovinges' point - once you're earning at a physician level, whether you pay the government half of an extra 50 to 100 k or not doesn't have to matter much beyond a savings and retirement issue.
 
I don't get it. Every position is filled. What does the number or percent of psychiatry residency applicants have to do with NPs or psychologists?
 
I had a medical neuropsychologist professor in undergrad. She was absolutely excellent. She did not prescribe as she couldn't in the state and only really did psych testing for her main job
 
When I was newly enrolled in my doctoral program, a couple of states passed RxP, I was excited about it because I thought it would be a good thing for psychologists to have that tool as it would benefit us and patients. After years of training and experience, my views have continued to shift more and more that psychologists‘ contribution to the field is and has been more valuable precisely because we focus on the psychological more than the biological. I am glad that psychiatrists focus on the biological and thus are the experts in that, but when it comes to understanding psychological dynamics of a case, I find that we are second to none. In my mind, we should put more energy into our knowledge of social and organizational psychology and delivery of services in systems because I think we could contribute greatly in that area. I think that would help our profession and mental health more than trying to aim for a second tier spot in pharmacology.
 
hebel said:
I actually think the real story is that psychiatry has stopped being a bottom-of-the-barrel specialty as far as competitiveness goes, so there's less "easy backup" applications being submitted by people gunning for another specialty because it's no longer a super easy match.
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I am heavily involved in medical student education. This is correct. The total number of applicants decreasing is not meaningful in this context. At the schools I have been affiliated with, we are continuing to see strong interest in psychiatry from strong applicants. The decline in applicants reflects a population of people who applied to psych BECAUSE it was an easy match, and now do not.

There were extremely few positions in SOAP this year and for the last several years. This is a much better indicator of trends in the specialty.
 
What’s the bottom of barrel now? And where your data to back that up.
 
Two observations. One is that regression to the mean makes this not surprising. We have been climbing for a decade and slipping for a couple of years was likely. The other is that if history repeats itself, we are all going to get raises as demand isn't met by supply. Doesn't bother me much. Yes, more mid levels will do our job because their aren't enough of us. That is the worst problem as I see it.
 
Techmed07 said:
What’s the bottom of barrel now? And where your data to back that up.
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Your chart isn't even right, it's some crappy chart from facebook with numbers that don't even match NRMP numbers. Dude the total number of applicants in that chart doesn't even match the total number of applicants for each year (ex. 2022 only had 42,549 applicants for ALL POSITIONS including R1 and R2 positions, those numbers on that chart add up to way more than that, pull out a calculator).

www.nrmp.org

Match Data

Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…
www.nrmp.org www.nrmp.org
From the actual match data (Table 1A of all these):
2022 applicants- 2908
2021 applicants- 2948
2020 applicants- 2798
2019 applicants- 2767
2018 applicants- 2739

I'm assuming that chart must be including people ranking multiple specialities and ranking psychiatry, maybe?? I have no idea, it looks made up.
 
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Techmed07 said:
View attachment 367750
Looking at the data it appears that the encroachment on our field is extremely problematic.
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Nah, it means less FMG and IMG applied to psych, because they know it’s not an easy match anymore, since in the past psych was an easy match for IMG. The speciality has become more competitive with US MD and DO students thus, less IMG have applied, so in reality, the number of US applicants to psych has increased.
 
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www.nrmp.org

NRMP® Celebrates Match Day by Publishing the Results of a Record-Breaking 2023 Main Residency Match®

The National Resident Matching Program® (NRMP®) celebrates the landmark milestone that is “Match Day” for the 2023 Main Residency Match with residency applicants, training programs, medical schools…
www.nrmp.org www.nrmp.org

Specialty Highlights and Competitiveness. The results of the Match can indicate the competitiveness of specialties as measured by the percentage of positions filled overall and the percentage of positions filled by U.S. MD and DO seniors.

  • The specialties with increases in the number of positions filled by U.S. MD seniors of more than ten percent and ten positions in the last five years (2019 – 2023) were Anesthesiology, Child Neurology, Interventional Radiology, Neurology, Pathology, Physical Medicine & Rehabilitation, Plastic Surgery (Integrated), Psychiatry, Radiology-Diagnostic, Transitional Year, and Vascular Surgery.
  • The specialties with increases in the number of positions filled by U.S. DO seniors of more than ten percent and ten positions in the last five years (2019 – 2023) were Child Neurology, Emergency Medicine, Family Medicine, Internal Medicine, Medicine-Pediatrics, Medicine-Primary, Neurology, Obstetrics & Gynecology, Orthopedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, Surgery, Surgery-Preliminary, and Transitional Year. While this may indicate a trend, this may also represent the maturation of the Single Accreditation System and the single Match.
 
nexus73 said:
I think psychiatry became more popular for a period of time, probably related to increased reimbursement with e/m coding and therapy add ons, and perceived improved acceptance by society and reduced stigma. But stigma still permeates everything I do at the hospital, even among doctors and physician administrators, who should know better or have better perspective on what psychiatry does. But in all fairness, they had 4 weeks of psych rotation in 3rd med school, so they really don't know what psychiatry is all about. And improved reimbursement is great, but inflation is running wild with no sign of reimbursement catching up. Getting a psych job at 280K sounds fine to pay off 200K in loans 5-10 years ago. But maybe the dream of psych as a lower paying ROAD specialty are going out the window with people eyeing the 400K plus starting salaries of anesthesia as they're facing down 500K in student loans.
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Physicians also had a behavioral health class during the first two years of med school with many questions on USMLE Step 1 about this. I can't remember if my psych rotation in med school was more than four weeks. I feel like it was at least two months. Not sure if things have changed now in med school. But either way then you have to pass a national exam standardized from the NBME to pass the rotation. And then the psych questions again on USMLE Step 2 and 3. I'm not saying this makes them sympathetic to psych but they do know at least more than a lot of midlevels out there. Not sure if in IM or FM residency if they do more rotations in psych.
 
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smalltownpsych said:
When I was newly enrolled in my doctoral program, a couple of states passed RxP, I was excited about it because I thought it would be a good thing for psychologists to have that tool as it would benefit us and patients. After years of training and experience, my views have continued to shift more and more that psychologists‘ contribution to the field is and has been more valuable precisely because we focus on the psychological more than the biological. I am glad that psychiatrists focus on the biological and thus are the experts in that, but when it comes to understanding psychological dynamics of a case, I find that we are second to none. In my mind, we should put more energy into our knowledge of social and organizational psychology and delivery of services in systems because I think we could contribute greatly in that area. I think that would help our profession and mental health more than trying to aim for a second tier spot in pharmacology.
Click to expand...
I agree with you about your excellent knowledge. When I refer a patient I always try to get a psychologist for them rather than a midlevel
 
Techmed07 said:
View attachment 367750
Looking at the data it appears that the encroachment on our field is extremely problematic.
Click to expand...
The number of US MD seniors and DOs applying psychiatry has actually increased between 2018 and 2022 by 120 applicants (though the number of slots has increased far more, as have the number of medical students overall). That would likely mean that the bulk of applicant decline is on the part of IMGs, who no longer view psychiatry as a backup specialty as much as in the past due to increased competitiveness
 
sorry if this was answered, were there any unmatched slots for Psych?
 
MedMan80 said:
sorry if this was answered, were there any unmatched slots for Psych?
Click to expand...
I think 21 unfilled and then post soap only 4 remained, but these were all newer programs. Basically it had a ~99% fill rate.
 
splik said:
Indeed. There are only about 225 prescribing psychologists in the US and it has taken 21 years for 6 states to enact prescribing psychologist legislation, most of which has significant restrictions or onerous requirements. In contrast, according to the AANP in 2018 there were 248000 NPs but by 2022 there were 355000. In 2016-2017, 1.7% of NPs were adult psych NPs and 2.1% were family psych, for 2020-2021 6.5% were psych NPs (who can now see children as well). The government projected a 65% increase in psych NPs between 2017 and 2030. Per the AANP state of the profession report, Psych/MH is the most lucrative certification for NPs. Psych NPs shockingly also write the most prescriptions out of all NPs, with a mean of 27 prescriptions per day.

Interestingly, workforce predictions suggest that the Psych NP field will become oversaturated in the next few years, whereas the demand for psychiatrists will continue to grow due to attrition of psychiatrists and changing workforce. According the HRSA: "Between 2017 and 2030, the total supply of all psychiatrists is projected to decline as retirements exceed new entrants. Rapid growth in supply of psychiatric nurse practitioners and psychiatric physician assistants may help blunt the shortfall of psychiatrists, but not fully offset it. In 2030, the supply of these three types of providers will not be sufficient to provide any higher level of care than the national average in 2017, which does not fully meet need."

Looking over the next 30 years, it becomes much harder to make accurate predictions, but the studies done so far indicate at best a minor surplus of psychiatrists by 2050, and at worst, a continued deficiency. In short, the sky isn't falling.
Click to expand...

Big players such as amazon, walmart and cvs are entering the game. Expect all midlevels in all states to be fully autonomous since it serves these guys well or massively increases the ratio of 1 doc can supervise 20-50 midlevels. They will get whatever the needed passed through congress we know this. Insurances are already doing their own tele doc thing and charging 0 or minimum copays. The model of the NP/PA being autonomous will kill most non procedural docs in medicine.

Hope this doesn't happen sooner than in the next 5 years. Allowing the NP to become autonomous essentially will end most non procedural needs especially when you can train 10x in supply at least 2-3x quicker than physicians with the whole online education. This is already happening faster than i thought 7 years out. Hope my time frame is off and its closer to 10 years but the writing is on the wall most don't know what's coming. Hope i am wrong i really really do. New docs wanting a 30 year career should be surgical for protection.
 
Mad Jack said:
The number of US MD seniors and DOs applying psychiatry has actually increased between 2018 and 2022 by 120 applicants (though the number of slots has increased far more, as have the number of medical students overall). That would likely mean that the bulk of applicant decline is on the part of IMGs, who no longer view psychiatry as a backup specialty as much as in the past due to increased competitiveness
Click to expand...
This is correct. A record-breaking number of both US MDs and DOs applied to psychiatry this year. The net decrease in applicants is entirely due to a large drop in IMGs/FMGs (likely due to the specialty's increased competitiveness).

Applicant data from ERAS:

1679239840627.png
 
smalltownpsych said:
When I was newly enrolled in my doctoral program, a couple of states passed RxP, I was excited about it because I thought it would be a good thing for psychologists to have that tool as it would benefit us and patients. After years of training and experience, my views have continued to shift more and more that psychologists‘ contribution to the field is and has been more valuable precisely because we focus on the psychological more than the biological. I am glad that psychiatrists focus on the biological and thus are the experts in that, but when it comes to understanding psychological dynamics of a case, I find that we are second to none. In my mind, we should put more energy into our knowledge of social and organizational psychology and delivery of services in systems because I think we could contribute greatly in that area. I think that would help our profession and mental health more than trying to aim for a second tier spot in pharmacology.
Click to expand...
I appreciate the psychologists I work with precisely because of their extensive experience in areas of which I have only superficial knowledge and skills. If I have a patient that needs certain treatments or testing, I would be doing a disservice much of the time if I attempted to do it myself in lieu of referring to someone better equipped and qualified to provide the services needed. I feel like the same goes the other way- I just can't imagine that a psychologist, even with two years of extra training, would be able to safely and competently prescribe medications and understand how they interact with various medical treatments and comorbidities, as well as to form full medical differentials for psychiatric conditions. We're different in what we do, and it's better to let each of us be strong in our area and to work together than to try and take turf from one another that we wont have the qualifications to back up.
 
finalpsychyear said:
Big players such as amazon, walmart and cvs are entering the game. Expect all midlevels in all states to be fully autonomous since it serves these guys well or massively increases the ratio of 1 doc can supervise 20-50 midlevels. They will get whatever the needed passed through congress we know this. Insurances are already doing their own tele doc thing and charging 0 or minimum copays. The model of the NP/PA being autonomous will kill most non procedural docs in medicine.

Hope this doesn't happen sooner than in the next 5 years. Allowing the NP to become autonomous essentially will end most non procedural needs especially when you can train 10x in supply at least 2-3x quicker than physicians with the whole online education. This is already happening faster than i thought 7 years out. Hope my time frame is off and its closer to 10 years but the writing is on the wall most don't know what's coming. Hope i am wrong i really really do. New docs wanting a 30 year career should be surgical for protection.
Click to expand...
I can point to any number of failed telepsych ventures to show that this idea is a bit overblown.
 
finalpsychyear said:
Big players such as amazon, walmart and cvs are entering the game. Expect all midlevels in all states to be fully autonomous since it serves these guys well or massively increases the ratio of 1 doc can supervise 20-50 midlevels. They will get whatever the needed passed through congress we know this. Insurances are already doing their own tele doc thing and charging 0 or minimum copays. The model of the NP/PA being autonomous will kill most non procedural docs in medicine.

Hope this doesn't happen sooner than in the next 5 years. Allowing the NP to become autonomous essentially will end most non procedural needs especially when you can train 10x in supply at least 2-3x quicker than physicians with the whole online education. This is already happening faster than i thought 7 years out. Hope my time frame is off and its closer to 10 years but the writing is on the wall most don't know what's coming. Hope i am wrong i really really do. New docs wanting a 30 year career should be surgical for protection.
Click to expand...
Nps tried to infiltrate GI for routine colonoscopy. There was a program at Hopkins for them. GI groups put a stop to that nonsense.
 
Mad Jack said:
I appreciate the psychologists I work with precisely because of their extensive experience in areas of which I have only superficial knowledge and skills. If I have a patient that needs certain treatments or testing, I would be doing a disservice much of the time if I attempted to do it myself in lieu of referring to someone better equipped and qualified to provide the services needed. I feel like the same goes the other way- I just can't imagine that a psychologist, even with two years of extra training, would be able to safely and competently prescribe medications and understand how they interact with various medical treatments and comorbidities, as well as to form full medical differentials for psychiatric conditions. We're different in what we do, and it's better to let each of us be strong in our area and to work together than to try and take turf from one another that we wont have the qualifications to back up.
Click to expand...
It's not two true years of training. Psychologists are still practicing full time psychology and doing the rxp training on the side
 
Mad Jack said:
I can point to any number of failed telepsych ventures to show that this idea is a bit overblown.
Click to expand...
Those were the ones doing controlled subs that got shut down. Tele will take the low hanging fruit and leave the harder cases for us. They reject the more complex cases as they should.
 
MedMan80 said:
The complex cases will always be there for us, I've conditioned myself to be happy with 200K/year (i don;t think we'll ever go under that), in case our salary's get diluted in the future.
Click to expand...

Yes and if it did go to that point you'd have a supply and demand correction of no one applying thus increasing the demand eventually.
 
finalpsychyear said:
I hope they all continue to fail. I'm hedging my bets with working my ass off till 2030. Feel like most will be caught like a deer in the headlights but again i hope I am wrong.
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Well, my job is going to be in academics anyway, so high salary may not be there but if things get bad, there'll always be residents that need training
 
finalpsychyear said:
Big players such as amazon, walmart and cvs are entering the game. Expect all midlevels in all states to be fully autonomous since it serves these guys well or massively increases the ratio of 1 doc can supervise 20-50 midlevels. They will get whatever the needed passed through congress we know this. Insurances are already doing their own tele doc thing and charging 0 or minimum copays. The model of the NP/PA being autonomous will kill most non procedural docs in medicine.

Hope this doesn't happen sooner than in the next 5 years. Allowing the NP to become autonomous essentially will end most non procedural needs especially when you can train 10x in supply at least 2-3x quicker than physicians with the whole online education. This is already happening faster than i thought 7 years out. Hope my time frame is off and its closer to 10 years but the writing is on the wall most don't know what's coming. Hope i am wrong i really really do. New docs wanting a 30 year career should be surgical for protection.
Click to expand...
At the end of the day, the basic principles of the market and economics apply. Supply and demand. But also, if you are a superior product, that product will sell better. My understanding is that a lot of these insurance companies who offer their own telepsych services pay terribly, they sound like close to bottom of the barrel gigs. It's also not easy for mid levels to get paneled with insurances, especially the good ones. The insurances they do get on, offer them terrible terrible rates. They are still more willing to work with a psychiatrist believe it or not. There's many independent NPs in my state. They're taking the scraps and mostly survive off Medicaid patients. Complex patients, low reimbursement, cannot charge for no shows, all that great stuff. My office is sitting high and pretty, we get first dibs--as it should because the providers here are top tier and that word gets around.
MedMan80 said:
The complex cases will always be there for us, I've conditioned myself to be happy with 200K/year (i don;t think we'll ever go under that), in case our salary's get diluted in the future.
Click to expand...
I don't think diluted pay is going to happen. Although, it may call on more business smarts on the physician's end though. We could use more training in the financial piece and how to gain our independence back (or middle men will keep trying to encroach-I see them as the bigger threat). Interestingly, I do see that NPs can have convincing bedside manner and potentially stronger entrepreneurial skills. But those skills, we can learn too (and excel). Love love love private practice. We only pay for overhead/supportive staff that actually earn their keep. The rest, all us providers take home. Every penny we deserve, no leeching here.
 
randomdoc1 said:
At the end of the day, the basic principles of the market and economics apply. Supply and demand. But also, if you are a superior product, that product will sell better. My understanding is that a lot of these insurance companies who offer their own telepsych services pay terribly, they sound like close to bottom of the barrel gigs. It's also not easy for mid levels to get paneled with insurances, especially the good ones. The insurances they do get on, offer them terrible terrible rates. They are still more willing to work with a psychiatrist believe it or not. There's many independent NPs in my state. They're taking the scraps and mostly survive off Medicaid patients. Complex patients, low reimbursement, cannot charge for no shows, all that great stuff. My office is sitting high and pretty, we get first dibs--as it should because the providers here are top tier and that word gets around.

I don't think diluted pay is going to happen. Although, it may call on more business smarts on the physician's end though. We could use more training in the financial piece and how to gain our independence back. Interestingly, I do see that NPs can have convincing bedside manner and potentially stronger entrepreneurial skills. But those skills, we can learn too (and excel).
Click to expand...

Just my opinion on the future employed psych. I am less concerned about the PP part of psych but that is a small percentage. I was the only 1 of 7 residents thus far in 7 years to go that route so i feel that is the minority.
 
finalpsychyear said:
Just my opinion on the future employed psych. I am less concerned about the PP part of psych but that is a small percentage. I was the only 1 of 7 residents thus far in 7 years to go that route so i feel that is the minority.
Click to expand...
If your supposition is that you work hard in med school, kind-of-hard in residency, and then walk into a hospital employed job that allows you to deliver great care without any work to know or set up anything related to a practice, have good admin support, and make 300k/year adjusted for inflation with sufficient PTO then absolutely that pathway is already dying (if it was ever alive).

You are not owed a great job just because you completed a residency just like you are not owed a great job because you completed a JD or MBA at Harvard. It is possible to understand the business side of medicine as part of training or done independently while in training and those that don't can and will continue to go through the grinder of poor employed jobs.
 
Merovinge said:
If your supposition is that you work hard in med school, kind-of-hard in residency, and then walk into a hospital employed job that allows you to deliver great care without any work to know or set up anything related to a practice, have good admin support, and make 300k/year adjusted for inflation with sufficient PTO then absolutely that pathway is already dying (if it was ever alive).

You are not owed a great job just because you completed a residency just like you are not owed a great job because you completed a JD or MBA at Harvard. It is possible to understand the business side of medicine as part of training or done independently while in training and those that don't can and will continue to go through the grinder of poor employed jobs.
Click to expand...
This is why we need to unionize. Equating JD, MBA to a MD is wild.
 
Techmed07 said:
This is why we need to unionize. Equating JD, MBA to a MD is wild.
Click to expand...
The full quote was a JD or MBA from HARVARD. The arguably best JD and MBA program in the country and one of the very best in the entire world. My point was someone even with a more prestigious and difficult to get into degree still needs to work to land a big time job. I would otherwise agree that the average MD has a more difficult training pathway than the average JD or MBA but that's not at all the point I was making.
 
Techmed07 said:
This is why we need to unionize. Equating JD, MBA to a MD is wild.
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This would probably be the worst thing to do for the medical profession. The powers that be are already setting up docs as the wealthy and privileged fall guys in the system, just try going on strike and see how quickly the system replaces with the lowly NPs and more admins to oversee and obfuscate.
 
RNs have done a really good job at unionizing degrees...
 
comp1 said:
RNs have done a really good job at unionizing degrees...
Click to expand...

No they haven't. There's plenty of nurses who work in non-union jobs. Just like there are grocery store employees who are part of a union and others who aren't (sometimes working right next to each other in the same store).

The idea that "doctors should unionize" is a nonsensical statement. The idea that "employed physicians (labor/employees) working at Cleveland Clinic should form a union for collective bargaining with the Clinic (employer)" is an actual actionable idea.
 
20% of RNs are in a union. 7% of MDs are (and many of those are only due to residency). When people say MDs should unionize, they mean that they should have a higher percentage. There is no national union for pretty much anything, degree or otherwise. Of course different hospitals, particularly in a geographic area, could potentially have a single union. Even federal employees have a couple of different unions. A certain amount of both nurses and physicians will never be able to be in a union because they work in too small of a practice or are self employed.
 
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Techmed07 said:
What’s the bottom of barrel now? And where your data to back that up.
Click to expand...
EM is officially the least competitive specialty now with ~550 spots unfilled (pre soap) or ~18% overall compared to ~11.8 FM

I don't have the link on me but there are many posts in the EM thread now with the most recent data
 
Merovinge said:
If you are facing down 500k in student loans the answer is abundantly clear that PSLF is the way to go
Click to expand...

This is definitely good advice but what about someone who maybe works two jobs or has one of those crazy paying 1099 jobs.. and just puts every possible dollar into repayment for a year?
 
Over half of the counties in the United States have zero psychiatrists. Not one. Even less have child and adolescent psychiatrists. The idea that there will suddenly be no jobs in the field is ridiculous. I just learned of yet another unit in the Northeast going back to psychiatrist-only because NPs couldn't handle the workload or acuity. Most people getting NPs think the field is easy money, just dispensing SSRIs. When they find out that is not the case they tend to bail.
 
Fluidity of Movement said:
This is definitely good advice but what about someone who maybe works two jobs or has one of those crazy paying 1099 jobs.. and just puts every possible dollar into repayment for a year?
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Sure, of course individual cases will vary but paying of 500k with post tax dollars in a year would be looking at around 1 million gross, so maybe 0.01% of psychiatrists their first year out of training?

The whole magic of PSLF (and why it's actually a good idea for doctors, even if the goal was more for teachers/social workers/etc), is that you do NOT need to take such jobs that surely sacrifice your patient's health, your health as the doc, or both. You can make your modest payments for 5-6 years after training and never worry about anything else with the loans, simple as that. Easy to budget around, you will still get an effective pay raise when the payments go away, and you can work a job that can be humane and why you hopefully set out to be a physician in the first place.
 
Merovinge said:
Sure, of course individual cases will vary but paying of 500k with post tax dollars in a year would be looking at around 1 million gross, so maybe 0.01% of psychiatrists their first year out of training?
Click to expand...

OH haha, I didn't mean paying (all) of it off in one year. That would be crazy, but a really big chunk. Bringing it down to normal levels at least.

Merovinge said:
The whole magic of PSLF (and why it's actually a good idea for doctors, even if the goal was more for teachers/social workers/etc), is that you do NOT need to take such jobs that surely sacrifice your patient's health, your health as the doc, or both. You can make your modest payments for 5-6 years after training and never worry about anything else with the loans, simple as that. Easy to budget around, you will still get an effective pay raise when the payments go away, and you can work a job that can be humane and why you hopefully set out to be a physician in the first place.
Click to expand...

I thought PLSF was 10 years?
 
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